Provider Demographics
NPI:1578304986
Name:THOMPSON, SOPHIA ANN (OTR/L, EP-C)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTR/L, EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 EDGEWATER BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4420
Mailing Address - Country:US
Mailing Address - Phone:904-314-7131
Mailing Address - Fax:
Practice Address - Street 1:14410 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4341
Practice Address - Country:US
Practice Address - Phone:904-314-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist